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Overactive bladder - causes, symptoms and treatment

2025-06-10
Overactive bladder - causes, symptoms and treatment

Overactive bladder syndrome (OAB) is a condition that affects the urinary system, leading to various symptoms and discomfort. It is characterized by an overactive bladder, which manifests as a frequent and urgent need to urinate.

Treatment of OAB is a complex process requiring an individualized approach and often includes both pharmacological methods and lifestyle changes. A key aspect of treatment is understanding the underlying causes, which may include bladder denervation, which significantly impacts bladder function. Frequent urination, one of the main symptoms, can impact patients' quality of life, so it is important for those suffering from this syndrome to seek professional medical help. Diagnosis and appropriate treatment can significantly improve the quality of life for those with OAB. Learn about the characteristic symptoms of OAB in both women and men, and how to cope with the problem of sudden bladder pressure.

  

Urinary Incontinence - Introduction

Regular, uncontrolled leakage of urine from the bladder, which is involuntary, is both a hygienic and social problem. Despite significant symptoms, fewer than half of women report their symptoms to a doctor. Unfortunately, those affected often withdraw from active social and professional life, which negatively impacts their well-being and quality of life. It is estimated that approximately 5 million Poles struggle with this problem. Urinary incontinence affects 25 to 45% of women, depending on age, while one in five men experiences difficulty urinating and controlling urine. The risk of this problem increases significantly in men after medical surgery.

Treatment for urinary incontinence focuses on eliminating the factors that aggravate the condition, changing lifestyle and introducing healthy daily habits, physiotherapy, pharmacotherapy, and, as a last resort, surgical treatment. After surgery, physiotherapy is necessary to maintain the surgical results.

Physiotherapy methods used for urinary incontinence include:

 

Acceptable urination guidelines:

  • Maximum 300-600 ml of urine per void
  • No more than 1 void per night (if drinking heavily before bed)
  • Urination every 3-4 hours
  • Regular fluid intake throughout the day, totaling approximately 1-2 liters
  • The difference between fluid intake and excretion should be approximately 500 ml
  • Urination up to 11 times per day

You should drink and use the toilet at regular intervals, remembering that not drinking water will not solve the problem and will only make it worse.

   

Classification of urinary incontinence by type:

  • Stress urinary incontinence
  • Overactive bladder
  • Mixing urinary incontinence
  • Other - neurological

 

Overactive bladder - clinical classification of the condition (OAB)

  • Dry OAB (without urinary incontinence)
  • Wet OAB (with episodes of urine loss)

 

Overactive bladder with/without urge incontinence

This type of urinary incontinence presents with bladder symptoms, which often urge to empty, despite having a small urine capacity. It is characterized by an uncontrollable urge to urinate at night and during the day. This is caused by overactivity of the detrusor, i.e., the smooth muscle of the bladder. It involves voiding disorders caused by a loss of balance between the mechanisms that inhibit and stimulate the detrusor muscle. There is a dry form (without urinary incontinence) and a wet form (with episodes of urine loss). It is important to rule out a possible urinary tract infection for proper diagnosis. The problem occurs in both women and men, and untreated overactive bladder syndrome can significantly deteriorate mental and physical health.

Studies conducted in Europeans indicate that the problem affects 17.4% of women and 15.6% of men. For the bladder to function properly, an intact nervous system pathway is required, which includes the brainstem, spinal cord, peripheral nerves, and bladder. Damage to any of the CNS centers can cause various urinary symptoms. The main neurological causes are:

Damage:

Above the pons – after a stroke, during Parkinson's disease, or in dementia. The detrusor muscle becomes overactive, reducing bladder capacity.

In the S2-S4 spinal cord, the micturition center – this is where the bladder becomes overfilled due to the inability to reflexively contract. The bladder begins to become involuntary, contracting ineffectively, which prevents adequate urination and further leads to urine retention and loss from overflow, while the bladder becomes flaccid and dilated.

The spinal cord above the micturition center - the bladder contracts unexpectedly and involuntarily, and urination is dependent on reflexes from the sacral spine.

 

Symptoms of Overactive Bladder and Diagnosis of Other Conditions

Diagnosing overactive bladder often requires an integrated approach to identify the causes of symptoms and rule out other possible conditions. Excessive bladder contractions may not be solely the result of bladder denervation, so it's important to consult a doctor for a complete evaluation.

One diagnostic tool that can be used in this process is ultrasonography (USG), especially urinary tract ultrasound. Here are some key points about the role of abdominal ultrasound in diagnosing OAB:

  • Bladder Assessment: Ultrasound allows for the assessment of the size, shape, and position of the bladder, as well as checking whether the bladder is emptying completely. Residual urine after voiding (so-called residual urine) may indicate bladder function problems.
  • Detecting Abnormalities: Ultrasound can help identify structural abnormalities, such as bladder stones, tumors, or other abnormalities, that may contribute to OAB symptoms.
  • Non-invasive Methods: Ultrasound is a non-invasive procedure, making it safe and relatively comfortable for the patient.
  • Ruling Out Other Conditions: Ultrasound also helps rule out other urinary tract conditions that may cause similar symptoms, such as urinary tract infections or prostate enlargement in men.
  • Evaluating Renal Function: Renal ultrasound is part of the overall assessment of the urinary tract. It allows for the detection of any abnormalities in the kidneys that may affect bladder function.

 

Bladder habits are formed in childhood.

The bladder "learns" habits between the ages of 2 and 5. Therefore, it is important to establish proper toileting habits from an early age.

   

Normal urinary urgency can be divided into three stages (needs):

  • Use 1: a slight feeling of urgency (100-150ml)
  • Use 2: an intense feeling of urgency (150-300ml)
  • Use 3: an uncontrollable feeling of urgency


Symptoms of Overactive Bladder Syndrome (OAB):

The most common symptoms of an overactive bladder are:

  • daytime urinary frequency
  • nocturnal urinary frequency
  • urgency - a sudden, often difficult-to-control feeling of needing to urinate immediately, which can occur suddenly and without warning
  • presence (OAB wet) or absence (OAB dry) of urinary incontinence
  • the problem involves the bladder
  • strong urge to urinate with a small bladder filling
  • frequent, painful urges
  • usually results in significant urine loss before the person can reach the toilet

 

Overactive Bladder - causes:

  • Chronic lower urinary tract infection
  • Organ prolapse
  • Estrogen deficiency - sensitive Mucosa
  • Physical and mental stress
  • Habits, habits, upbringing
  • Urinating "in excess"
  • Low fluid intake
  • Cold
  • Surgery, pelvic injuries
  • Obesity
  • Diabetes
  • Multiple sclerosis
  • Overactive bowel syndrome


How to treat an overactive bladder?

Surgical treatment is used quite often, but it should be a last resort. It's important to remember that after surgery, you should exercise your bladder and pelvic floor muscles, because without them, the problem will return – conservative treatment.

Botox is also used for treatment, which aims to calm the bladder. Anyone struggling with urinary incontinence should see a doctor and a gynecological physiotherapist for proper diagnosis and treatment. Curing an overactive bladder and saying goodbye to this painful problem is entirely possible.

  

Physiotherapeutic treatment for overactive bladder

  • percutaneous tibial nerve stimulation (PTNS), and for non-oncological patients, electrostimulation can be incorporated into the therapy, both strengthening the pelvic floor muscles and calming the overactive bladder via the tibial nerve, transpubic, or transanal, directly affecting the bladder.
  • EMG biofeedback and pressure biofeedback,
  • behavioral training,
  • learning how to properly defecate using a resistive exhalation with a breathing mouthpiece that allows for the proper distribution of intra-abdominal pressure and the proper direction of the urge to defecate.

 

Electrotherapy for overactive bladder syndrome

This is a passive method of treating urinary incontinence and involves stimulating nerve endings in the skin or inducing muscle contraction using pulsed currents. For pelvic floor electrostimulation to be effective, at least partial preservation of innervation in this part of the body is necessary.

The use of TENS currents allows for:

  • stimulation of muscles to contract, so the patient knows that a contraction is possible,
  • restarting the central (conscious) mechanism of muscle movement control and rebuilding the reflex arc,
  • slowing down detrusor contraction through the perineal-detrusor reflex (PDM tension),
  • impacting muscle tissue trophism (thanks to improved blood supply and PDM strengthening),
  • providing analgesic effects on the pelvic area, e.g., during childbirth, on painful scars, etc.

 

Introducing Bladder Training

Increasing bladder capacity through exercise can be very helpful for people with overactive bladder syndrome (OAB) and others who experience frequent urination.

This training involves delaying the need to urinate and urinating at set times (approximately every 3 hours), rather than when the bladder tells us to. We train the bladder by extending the time between urinations. If we feel the urge to urinate earlier, we should use "delaying techniques" (described below) and try to hold out as long as possible to avoid going to the toilet immediately. This time should be increased with each subsequent visit until the goal of a 3-hour interval is achieved.

Patient education and a thorough explanation of the training principles are also important. Bladder training is effective, meaning the reduction or elimination of symptoms can be up to 90%.

  • Techniques for delaying urination
  • Keeping a voiding diary
  • Modifying lifestyle and toilet habits
  • Sustainable pelvic floor muscle training
  • Loosening, relaxation, and breathing exercises
  • Alternative methods: e.g., massage, reflexology, naturopathy
  • To calm the bladder, you need to strengthen your posture, i.e., the pelvic floor muscles

 

Lifestyle changes and overactive bladder

  • Maintain your acid-base balance
  • Avoid cold surfaces for sitting, or use warm sitz baths
  • Before urinating, warm the urethral opening slightly with a warm compress so that the skin is the same temperature as the urine
  • Naturopathy should help by replacing antibiotics, but natural products should be used as soon as the first symptoms are noticed
  • Regulate the vaginal flora by using plain yogurt and a good probiotic. After menopause, apply estrogen-containing creams to the vaginal opening to improve the condition of the mucosa.
  • During frosty weather, wear warm clothing around the pelvic area (e.g., a longer jacket, tights).
  • During infection-free periods, you can drink herbal teas to support your bladder.
  • Strengthen your immune system.
  • Drink blueberry juice, cactus flower tea, and cranberry juice.
  • Avoid carbonated and caffeinated drinks that irritate the bladder, as well as diuretic drinks.

 

Methods and exercises for calming an overactive bladder

  • Raising on tiptoes
  • Crossing and pressing the legs together
  • Touching the tendon center of the perineum with your hand or heel
  • Sitting on something that will compress the tendon center of the perineum
  • Pressing the clitoral area with your hand
  • Talking to the bladder, "Calm down, I can do this"
  • The technique of postponing going to the toilet, e.g., in 10 minutes, in small steps, until you reach a 3-hour interval between voids

 

Overactive Bladder Syndrome and People with Alzheimer's

The relationship between Alzheimer's disease and overactive bladder syndrome is complex and multifaceted. Alzheimer's disease, a progressive neurodegenerative disorder, affects various aspects of brain function, including those responsible for bladder control. As a result, Alzheimer's patients may experience problems with overactive bladder function, which manifests itself in frequent and urgent urges to urinate.

One of the challenges in treating OAB in Alzheimer's patients is that standard treatments, such as behavioral therapies and pharmacological therapies, may be less effective or more difficult to implement due to the memory and cognitive problems that accompany Alzheimer's disease. Furthermore, medications used to treat OAB can interact with medications used to treat Alzheimer's disease, requiring careful balancing and monitoring by a physician.

For Alzheimer's patients with OAB, it is important that the treatment approach is multidisciplinary and tailored to the individual's needs. This includes collaboration between neurologists, urologists, and behavioral therapists. Support from family and caregivers is often necessary to ensure appropriate care and symptom management for both Alzheimer's disease and overactive bladder syndrome.

   

Pelvic floor muscle functions

  • supporting internal organs to prevent them from moving downward,
  • reflex responses such as sneezing and coughing,
  • relaxation and opening during urination and defecation,
  • sexual function, relaxation during intercourse.

 

Mixed urinary incontinence - is it necessary to exercise pelvic floor muscles?

The combination of stress urinary incontinence and an overactive bladder is very common. This form of urinary incontinence is called mixed incontinence. In this case, it's also worth paying attention to the pelvic floor muscles, as the problem stems from, among other things, the weakening of these muscle structures.

Over the years, unexercised pelvic floor muscles lose their strength, and the problem can worsen. To prevent this, daily pelvic floor exercises and improving their trophic function are necessary. Pelvic floor muscles were once called Kegel muscles - they are the same structures, but with a different name.

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